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Abstract

Background: Normative feedback (NF), or receiving information about one’s drinking compared to peer drinking norms, is one of the most widely used brief interventions for prevention and intervention for hazardous alcohol use. NF has demonstrated predominantly small but significant effect sizes for intention to change and other drinking related outcomes. Identifying mechanisms of action may improve the effectiveness of NF; however, few studies have examined NF’s mechanisms of action, particularly among adults. Objective: This study is an exploratory analysis of two theorized mechanisms of NF: discrepancy (specifically personal dissonance—the affective response to feedback) and belief in the accuracy of feedback. Method: Using Amazon’s Mechanical Turk, 87 men (n=56) and women (n=31) completed an online survey during which they were asked about their perceptions about their drinking and actual drinking behaviors. Then participants were provided tailored NF and evaluated for their reactions. Severity of discrepancy was measured by the difference between one’s estimated percentile ranking of drinking compared to peers and actual percentile ranking. Surprise and worry reported due to the discrepancy were proxies for personal dissonance. Participants were also asked if they believed the feedback and if they had any plans to change their drinking. Mediation analyses were implemented, exploring whether surprise, worry, or belief in the accuracy of feedback mediated severity of discrepancy’s impact on plan for change. Results: Among this sample of adult drinkers, severity of discrepancy did not predict plan for change, and personal dissonance did not mediate severity of discrepancy. Severity of discrepancy was mediated by belief in the accuracy of feedback. In addition, viewing one’s drinking as a problem prior to feedback and post-NF worry both predicted plan for change independently. Conclusions: Results revealed that NF may not work to create personal dissonance through discrepancy, but belief in the accuracy of feedback may be important. It appears the more one believes the feedback, the more one makes a plan for change, suggesting practitioners should be mindful of how information within feedback is presented. Findings also indicate NF may work by validating a preexisting perception that drinking is a problem instead of creating concern related to discrepancy where none existed. Limitations regarding generalizability are discussed.

Supplemental Information

Raw dataset

Code for mediation analysis

Additional Information

Competing Interests

Frederick J. Muench is an Academic Editor for Peerj.

Author Contributions

Alexis Kuerbis conceived and designed the experiments, performed the experiments, analyzed the data, contributed reagents/materials/analysis tools, wrote the paper, prepared figures and/or tables, reviewed drafts of the paper.

Frederick J. Muench conceived and designed the experiments, performed the experiments, analyzed the data, contributed reagents/materials/analysis tools, wrote the paper, reviewed drafts of the paper.

Rufina Lee analyzed the data, wrote the paper, reviewed drafts of the paper.

Juan Pena analyzed the data, wrote the paper, reviewed drafts of the paper.

Lisa Hail performed the experiments, wrote the paper, reviewed drafts of the paper.

Human Ethics

The following information was supplied relating to ethical approvals (i.e., approving body and any reference numbers):

Hunter College IRB reviewed this project. It was deemed exempt for human subjects research because no identifying information was collected about our subjects. We have a letter to that effect.

Data Deposition

The following information was supplied regarding data availability:

The raw data has been supplied as a Supplemental Dataset.

Funding

This work was funded by National Institute on Alcohol Abuse and Alcoholism, in the United States, Grant R34 AA 021502A (PI: Muench). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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